An Evaluation of the Effectiveness and Process of a Rapid Response System

快速响应系统的有效性和流程评估

• 批准号: 7983926
• 负责人: Tanya Elise Lord
• 金额: $ 4.03万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-01 至 2011-08-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7983926
• 关键词: Evaluation; Effectiveness; Process; Rapid; Response

DESCRIPTION (provided by applicant): The Institute for Healthcare Improvement (IHI) has promoted implementing a RRS to provide safer care for hospitalized patients. Additionally, the Joint Commission made implementing a RRS a 2008 National Patient Safety Goal. Although mandated, the evidence to support the effectiveness of a RRS to reduce cardiac arrests on hospital medical or surgical floors, un-anticipated ICU transfers and all hospital mortality rates remains inconclusive, partly because of weak study designs and partly due to a failure of published studies to report all critical aspects of their intervention. Recently, two published reports have set guidelines for the methodological components that need to be included in published studies of RRS. This study will follow these guidelines to evaluate the effectiveness and the implementation of a RRS on the two campuses of the UMass Memorial Medical Center (UMMMC). The Specific Aims of the proposed research are to: 1) To evaluate the effectiveness of a RRS using a before/after study designed to measure changes in rates of cardiac arrest, un-anticipated ICU admissions from the floors, hospital mortality and code calls to the floor. The before period will consist of a review of the 12 months prior to the implementation of the RSS. The after period will be a review of the 24 months following the implementation of the RSS. 2) To conduct a process evaluation of the RRS intervention that will assess fidelity of RRS implementation, the proportion of the intended patient population that is reached by the RRS, the overall number of RRS calls implemented (dose delivered) and the perceptions of the hospital staff affected by the RRS with respect to acceptability and satisfaction with the RRS and barriers to utilization. An understanding of the effectiveness and the implementation of an RRS will help similar institutions implement or improve an RRS. PUBLIC HEALTH RELEVANCE: Studies have shown that there are often observable clinical antecedents (patient signs and symptoms) to cardiac and respiratory arrests and to ICU admission of patients receiving care on general hospital floors. Other evidence suggests that hospital clinical staff often do not respond effectively to these antecedent clinical findings. In theory, rapid response systems aimed at detection of these antecedents and effective management of the underlying cause/s may reduce the incidence of cardiac and respiratory arrests, of urgent, unplanned ICU admissions, and of in-hospital death among patients hospitalized outside of ICUs. However, evidence on the effectiveness of rapid response systems is limited and the optimal design of the systems is not known. Hospital staff time and energy are limited public health resources that should be allocated in the most cost effective manner. The proposed evaluation of a rapid response system will provide valid measures of the effectiveness of the intervention as well as an understanding of the operation and contribution of the components to the outcomes. The study findings will inform the ongoing national discussion about the benefits and costs of rapid response systems, and may ultimately contribute to a more efficient allocation of the relevant public health resources.

描述（由申请人提供）：医疗保健改善研究所（IHI）促进实施RRS，为住院患者提供更安全的护理。此外，联合委员会将实施RRS作为2008年国家患者安全目标。尽管有规定，但支持RRS减少医院内科或外科楼层心脏骤停、意外ICU转移和所有医院死亡率的有效性的证据仍然不确定，部分原因是研究设计薄弱，部分原因是已发表的研究未能报告其干预的所有关键方面。最近，两份已发表的报告为需要纳入已发表的RRS研究的方法组成部分制定了指导方针。本研究将遵循这些指南，以评估马萨诸塞大学纪念医学中心（UMMMC）两个校区的RRS的有效性和实施情况。拟议研究的具体目的是：1）使用设计用于测量心脏骤停率、楼层意外ICU入院率、医院死亡率和楼层呼叫代码的变化的前后研究来评价RRS的有效性。前一阶段将包括对RSS实施前12个月的审查。之后的一段时间将是对RSS实施后24个月的审查。2)对RRS干预进行过程评价，以评估RRS实施的保真度、RRS覆盖的预期患者人群比例、实施的RRS呼叫总数（输送剂量）以及受RRS影响的医院工作人员对RRS的可接受性和满意度以及使用障碍的看法。了解RRS的有效性和实施情况将有助于类似机构实施或改进RRS。 公共卫生相关性：研究表明，心脏和呼吸骤停以及在综合医院楼层接受护理的患者入住ICU时，通常存在可观察到的临床先兆（患者体征和症状）。其他证据表明，医院的临床工作人员往往不能有效地应对这些先前的临床结果。从理论上讲，旨在检测这些前因并有效管理根本原因的快速反应系统可能会降低心脏和呼吸骤停、紧急、计划外ICU入院以及在ICU外住院的患者的院内死亡的发生率。然而，关于快速反应系统的有效性的证据有限，系统的最佳设计也不清楚。医院工作人员的时间和精力是有限的公共卫生资源，应以最具成本效益的方式分配。拟议的快速反应系统评价将提供有效的措施来衡量干预措施的有效性，并了解各组成部分的运作和对成果的贡献。研究结果将为正在进行的关于快速反应系统的益处和成本的全国性讨论提供信息，并可能最终有助于更有效地分配相关的公共卫生资源。